An "all comers" policy for ruptured abdominal aortic aneurysms: how can results be improved?

OBJECTIVE

To review our experience of a non-selective policy for the treatment of ruptured abdominal aortic aneurysm to see if the policy was justified, and to identify any preoperative risk factors that adversely influenced outcome.

DESIGN

Retrospective study.

SETTING

Teaching hospital, Republic of Ireland.

SUBJECTS

258 patients admitted with abdominal aortic aneurysms between January 1982 and December 1993.

INTERVENTIONS

Definitive surgical treatment.

MAIN OUTCOME MEASURES

Morbidity, mortality, and risk factors.

RESULTS

In-hospital mortality for all patients was 43% (110/258). Overall, women did worse than men (28/44, 64%, died, compared with 96/214, 45%, p=0.03). The mortality among patients over the age of 80 (23/45, 51%) was not significantly different from that among younger patients (97/202, 48%). Blood pressure, platelet count, and haemoglobin concentration were all significantly lower preoperatively among those who died (p < 0.05).

CONCLUSIONS

Age alone cannot be used to justify witholding definitive surgical treatment. Treatment should be aimed towards reversing haematological and haemodynamic abnormalities preoperatively to try to improve outcome.